Chest Wall Masculinization: Our Treatment Algorithm
Estetic masculinization of the chest wall is one of the first surgical steps in female to male transsexual (FTMTS) reassignment.
This surgical procedure is not a simple mastectomy: it is required for removal of breast tissue with glandular resection and skin excess revision, to reduce and replace the nipple areola complex in the right location, minimizing chest-wall scars. The creation of an esthetically pleasing male chest allows the patient to live at ease in the male gender role.
We present our series of 68 FTMTS who underwent bilateral mastectomies for surgical sexual reassignment (a total of 136 mastectomies) according to our algorithm, in the period between January 2010 and December 2016.
¥ For small - medium breast volume, combined with good skin envelope elasticity, the "pull-through" technique is our first choice. This technique makes it possible to remove the breast parenchyma using only two small incisions, placed far away from the esthetic unit of the male breast;
¥ For similar small-medium breast volume, with less skin elasticity or "elastorhex striae", a concentric circular technique is better suited;
¥ For a moderate sized breast with poor skin elasticity and several "elastorhex striae", or large volume breasts with no excessive laxity, we suggest the "ultra-thin vertical bipedicle" technique, designed to remove skin and replace NAC;
¥ Large sized breasts or ptotic glands with poor skin elasticity require breast glandular resection with free nipple grafting.
We achieved a total complication rate of 6.6%, less than the literature; additional procedures for esthetic improvements were performed in 14.7% of cases. The mean patient satisfaction was about 4.57% out of a maximum value of 5 (excellent).
To help surgeons in choosing the most appropriate FTMTS surgical technique, and to reduce unfavorable results, we propose the use of our treatment algorithm in preoperative evaluation of the chest wall, according to the breast volume, degree of glandular ptosis and skin elasticity.